Forbes columnist Steven Salzberg and author-investigator Joe Nickell will each be awarded the 2012 Robert P. Balles Prize in Critical Thinking, to be presented by the Committee for Skeptical Inquiry at the CFI Summit in October.

Nope. Not true. Exactly backwards. Think about it: When you go to a doctor with a fever, does he just treat the symptom? No, he tries to figure out what’s causing the fever. If it’s pneumonia, he identifies which microbe is responsible and gives you the right drugs to treat that particular infection. If you have abdominal pain, does the doctor just give you narcotics to treat the symptom of pain? No, he tries to figure out what’s causing the pain. If he determines you have acute appendicitis, he operates to remove your appendix.

I guess what they’re trying to say is that something must have been wrong in the first place to allow the disease to develop. But they don’t have any better insight into what that something might be than scientific medicine. All they have is wild, imaginative guesses. And they all disagree with one another. The chiropractor says that if your spine is in proper alignment, you can’t get sick. Acupuncturists talk about the proper flow of qi through the meridians. Energy medicine practitioners talk about disturbances in energy fields. Nutrition faddists claim that people who eat right won’t get sick. None of them can produce any evidence to support these claims. No alternative medicine has been scientifically shown to prevent disease or cure it. If it had, it would have been incorporated into conventional medicine and would no longer be “alternative.”

Are these practitioners treating the underlying cause, or are they simply applying their one chosen tool to treat everything? Chiropractors treat every patient with chiropractic adjustments. What if a doctor used one treatment for everything? You have pneumonia? Here’s some penicillin. You have a broken leg? Here’s some penicillin. You have diabetes? Here’s some penicillin. Acupuncturists only know to stick needles in people. Homeopaths only know to give out ridiculously high dilutions that amount to nothing but water. Therapeutic touch practitioners only know to smooth out the wrinkles in imaginary energy fields. They are not trying to determine any underlying cause; they are just using one treatment indiscriminately.

How do you define “cause”? We don’t know what causes gravity, but we understand enough about how it works to overcome it with elevators, airplanes, and rockets to the moon. We may not know what ultimately causes asthma, but we know enough about the causes of airway constriction and inflammation to devise effective treatments.

Let’s take a simple example: strep throat. The symptom is throat pain. Doctors don’t just treat the pain; they do a throat culture, they determine that a strep infection is causing the pain, and they treat the infection with an antibiotic. But what caused the strep infection? The body had to host the bacteria and respond to their presence by developing symptoms; the bacteria had to be capable of multiplying in the human body. The patient had to be exposed to another person who had a strep infection, who in turn had caught it from someone else, involving a chain of social and epidemiologic causes. The bacteria had to evolve from ancestor bacteria and the human from ancestor animals. And so on.

So you see, it involves a chain of causation and there can even be several simultaneous causes. “Cause” can mean pretty much anything you want it to. But however you look at it, doctors definitely do not “just treat symptoms.”

Philosophy has studied causation. Aristotle said everything had four causes: material, formal, efficient, and final. And he introduced complications: proper (prior) causation and accidental (chance) causation. Potential or actual, particular or generic. Reciprocal or circular causality as a relation of mutual dependence or influence of cause upon effect. The same thing as the cause of contrary effects when its presence and absence result in different outcomes. He recognized that the subject of causation was complicated.

Alternative providers are more “simple” minded. They often claim to know the one true cause of all disease, which is curious because medical science defines several categories of causes falling under the mnemonic VINDICATE:

V – Vascular

I – Infectious/inflammatory

N – Neoplastic

D – Drugs/toxins

I – Intervention/iatrogenic

C – Congenital/developmental

A – Autoimmune

T – Trauma

E – Endocrine/metabolic

And sometimes more than one cause is involved (e.g., a traumatic injury gets infected). Where science finds complexity, alternative medicine imagines simplicity. As H.L. Mencken said, “For every complex problem, there is an answer that is clear, simple—and wrong.”

Some homeopaths claim to treat “genetic” illness, tracing its origins to six main genetic causes: tuberculosis, syphilis, gonorrhea, psora (scabies), cancer, and leprosy. Bet you didn’t know tuberculosis was genetic! Neither did I. Science classifies all these as infectious except for cancer, which is neoplastic. Homeopathy disregards science and redefines genetic to suit its own inscrutable purposes.

Science finds many causes for disease and sometimes more than one cause for a given disease. Pseudoscience has identified the one true cause of all disease—many times. I did an Internet search and found sixty-seven single causes of all disease (see accompanying box). This is not an exhaustive list but rather an exhausted list (I stopped when I got tired of searching).

It never seems to bother proponents of alternative medicine that others have found different “one true” causes. In his book Voodoo Science, Bob Park describes a press conference following a meeting to discuss government funding for alternative medicine research:

Perhaps the strangest part of the press conference consisted of brief statements by individual members of the editorial review board of what they saw as the most important issues for the Office of Alternative Medicine. One insisted that the number-one health problem in the United States is magnesium deficiency; another was convinced that the expanded use of acupuncture could revolutionize medicine; and so it went around the table, with each touting his or her preferred therapy. But there was no sense of conflict or rivalry. As each spoke, the others would nod in agreement. The purpose of the OAM, I began to realize, was to demonstrate that these disparate therapies all work. It was my first glimpse of what holds alternative medicine together: there is no internal dissent in a community that feels itself besieged from the outside.

When scientists encounter two mutually exclusive claims, it bothers them. They experience cognitive dissonance and try diligently to find evidence to reject one of the hypotheses and leave a winner. They eventually reach a consensus. Alternative medicine pseudoscientists don’t seem to mind cognitive dissonance. They are content to look for evidence to support their own chosen treatment while blithely disregarding competing claims. They don’t want to look for evidence that something doesn’t work. While each claims to know the one cause of disease, they don’t seem interested in looking for the one truth.

Live and let live? Create your own reality? Truth is only relative? The same thing may be simultaneously true for me and false for you? Maybe it boils down to a mutual tolerance of delusions (okay, I’ll believe that you are Jesus if you believe that I’m Napoleon). For the cynical, follow the money: “I won’t interfere with your livelihood if you don’t interfere with mine.”

I can play the cause-finding game too. I’ve discovered the one cause of all the one-cause theories: a deficiency of critical-thinking skills combined with an overactive imagination. And, of course, a failure to test beliefs using the scientific method.

Harriet Hall

Harriet Hall, MD, a retired Air Force physician and flight surgeon, writes and educates about pseudoscientific and so-called alternative
medicine. She is a contributing editor and frequent contributor to the Skeptical Inquirer and contributes to the blog Science-Based Medicine.
She is author of Women Aren’t Supposed to Fly: Memoirs of a Female Flight Surgeon and coauthor of the 2012 textbook Consumer Health: A Guide to
Intelligent Decisions.

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